SCIE Knowledge review 13: Outcomes-focused services for older people

By Caroline Glendinning, Sue Clarke, Phillipa Hare, Inna Kotchetkova, Jane Maddison and Liz Newbronner

Published: January 2007

This knowledge review includes a review of research evidence on the outcomes valued by older people and a practice survey that aims to identify the factors that facilitate and inhibit achieving desired outcomes. It also contains a postal survey of localities and social services managers in England and Wales known to be interested in developing outcomes-focused approaches to older people's services; and in-depth studies in six localities.

Key messages

The factors that older people identify as central to their independence and well-being can be categorised as three types of outcome

Outcomes involving change

• Improvements in physical symptoms and behaviour.
• Improvements in physical functioning and mobility.
• Improvements in morale.

Outcomes involving maintenance or prevention

• Meeting basic physical needs.
• Ensuring personal safety and security.
• Having a clean and tidy home environment.
• Keeping alert and active.
• Having social contact and company, including opportunities to contribute as well as receive help.
• Having control over daily routines.

Service process outcomes

These refer to the ways that services are accessed and delivered and include:

• Feeling valued and respected.
• Being treated as an individual.
• Having a say and control over services.
• Value for money.
• A good ‘fit’ with other sources of support.
• Compatibility with, and respect for, cultural and religious preferences.

Evidence shows that many of the outcomes desired by older people do not, on the face of it, appear to be derived from interventions that currently fall within the remit of social care services. There is also evidence that practitioners and services tend to focus on ‘change’ outcomes, while older people place a higher value on maintenance and prevention outcomes.

Factors reported as helping an outcomes approach

• National policies such as the older people’s national service framework and Independence, well-being and choice.
• New inspection regimes for residential care which encourage an outcomes approach.
• Local vision, leadership and investment in change management.
• Access to resources and skills beyond the traditional remit of social care.

Factors hindering the development of an outcomes approach

• The single assessment process, with its needs-based paperwork.
• Performance indicators which do not reflect outcomes.
• Resource constraints.
• Staff culture and attitudes.
• Service-led or dependency-focused assessments.
• Lack of regular review.
• Purchasing arrangements which constrain providers’ flexibility to work in an outcomes-focused way with service users.

Context

For a long time older people have been passive recipients of social care services. The provision of services has also been led by what was available rather than by what outcomes older people wanted. The Department of Health white paper Our health, our care, our say highlighted the need for services for all people, including older people, to be outcomes-focused.

Purpose

The knowledge review aimed to identify:

• the outcomes that are valued by older people and their carers
• the organisational and other factors that help or hinder the delivery of desired outcomes
• examples of good practice in outcomes-focused, person-centred services for older people and their carers.

'Outcomes' are defined as the impact, or end-results, of services on a person's life; therefore outcomes-focused services are those that aim to achieve the priorities that service users themselves identify as important.

Audience

This knowledge review is intended for use by SCIE as the basis of further work on outcomes-focused services for older people. It will also be useful to other organisations with an interest in this area.